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97 poster Intraluminal high dose rate brachytherapy for ano-rectal cancer - mount vernon experience
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Posters
ity rate was 22.5%) while 3 died of intercurrent diseases. The 5-year actuarial disease-free survival rate was 56% while the 5-year actuarial overall survival was 70%. Five patients (17%) developed severe wound complications following surgery/brachytherapy and 6 (19%) developed late local tissue toxicity (fibrosis and telangiectasia). Conclusions: Wide local excision followed by interstitial brachytherapy has resulted in an 87% local control rate with a 17% local complication rate. 94
poster
None fracture occurence after surgery, brachytherapy (BCT) and external beam irradiation (EBRT) in soft tissue sarcoma (STS) of the limbs F. Paiar 1, L. Livi 1, G. Piperno 1, S. Scoccianti 1, R. Santoni2, G, Biti 1 1Department of Radiation Oncology, University of Firenze and Roma, 2Tor Vergata, Italy Introduction: in spite of the good results in terms of survival and local control rates after combined treatment (radical surgery followed by irradiation with high doses) of STS the occurrence of severe long term side effects has not yet been fully investigated or reported. In particular the occurrence rate of long bone fractures is not well known, as well as its treatment and outcome. Material and methods: during the period 1990-2000 243 patients affected by STS of the trunk and limbs were referred to the University and Hospital Departments of Orthopaedics and Radiation Therapy of Firenze, Italy. Treatment protocol is based on wide surgical resection of the tumor usually followed by intraoperative implantatioin of catheters for BCT, EBRT is then added to cover a larger volume than that treated with BCT only. BCT is usually delivered a few days after surgery and implantation, in the operative room during resection, of the plastic catheters which will bear the radioactive sources during treatment. Catheters are implanted perpendicular to the surgical wound over its length to cover the tumor bed with a safety margin of 2 - 3 cm. Using 192 Iridium low-dose-rate sources doses ranging between 12 Gy and 60 Gy were delivered to a larger volume then that covered by the BCT treatment. EBRT was usually planned with two opposed fields using high energy photon beams or a direct electron beam field. The total doses delivered to the entire compartment containing the excised tumor ranged between 47 Gy and 95 Gy (median dose 75 Gy). Results: with a median follow-up period of 48 months the 5 year overall survival and relapse free survival were 66% and 69% respectively. Long bone fractures were diagnosed in three patients and all of them required a major surgical treatment (amputation of the leg in one patient). To detect a possible correlation between bone fracture, treatment, patient related factors or tumor related factors these patients were matched towards a group with similar clinical and pathologic features. No differences were found as concerns predictors of increased risk of long bone fracture between the control group and the three reported cases. The authors will describe the features of the entire group of treated patients and the three cases who experienced spontaneous bone fracture during follow-up.
MISCELLANEOUS 95
poster
Geometric analysis of the change of ovoids applicator positions, iCRU-38 rectum and bladder points during multiple HDR brachytherapy fractions F.G. Koseoglu 1, M. Garipagaoglu 1, H. GEflkesen2, N. Tungel 1, A.U. Kizildag 1, M.G. Dalmaz 1, V. Simsir 1, M. Altun 1 1Akdeniz University School of Medicine, Radiation Oncology, Antalya, Turkey 2Akdeniz University School of Medicine, Bioistatistics, Antalya, Turkey Introduction: The reproducibility of intracavitary brachytherapy (IB) applicator positions between fractions is important. Treatment planning and plan optimization for each fraction are recommended by several authors since variation of applicator position, between the fractions. This study investigates the interfractional geometric variation of the High Dose Rate (HDR) IB application using two ovoids for vaginal cuff irradiation, and ICRU-38 rectal reference point (R) and ICRU-38 bladder reference point (BL). Methods: Twenty-four patients with cervical or endometrial carcinoma underwent HDR IB using 2 ovoids were included. Our protocol requires, treatment dose calculation and optimization in each IB fractions using orthogonal radiographs. The point where is located intersection of the line passing over the widest distance of pelvic space in x-axis and the line between middle of lumbar 5 vertebra and middle of upper symphysis pubis
(SP) in y-axis defined as a pelvic centre (PC). On orthogonal radiographs, PC, left pelvic wall (LPW) and right pelvic wall (RPW), upper-middle of the sacral 1 vertebra ($1) and SP were taken as "constant reference points". Top of the right ovoid (RO) and left ovoid (LO), R and BL were defined as "inconstant points". In an effort to obtain the changes of applicator positions, R and BL; 32 different parameters were defined to resemble the distance between constant and inconstant points in x, y and z axis. These 32 parameters were measured, in each HDR IB fraction of 24 patients, with using orthogonal radiographs. To test the significance of change of the parameters within each patient, Friedman test was used. Results: The distance between the ovoids were same in all fractions of each patient. The difference between maximum and minimum of each parameter for each patient was determined. The mean of these differences in x, y and. z axis were: 7.6ram, 13.2mm, 14.2mm for left ovoid, 8.3ram, 13.3mm, 19.5mm for right ovoid, 5.5mm, 19.3mm, 15.4mm for rectum, 13.0 ram, 8.5mm, 10.9mm for bladder respectively. There was no statistically significant change in any measurement for left and right ovoid or R and BL within these subjects. Conclusion: Necessity of treatment planning and optimization in each vaginal cuff HDR IB fractions, with using two ovoids should be analysed by a dosimetric study. 96
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Endourethral brachytherapy for prevention of recurrent urethral stricture following internal urethrotomy - First experiences M.-H. S~eoenschmiedt 1, 72 Olschewski 1, D. KrOpfl2 1AIfried Krupp Hospital, Radiooncology, Radiotherapy, Nuclear Medicine, Essen, Germany 2Huyssens-Stiftung, Urology, Essen, Germany Introduction: Urethral strictures often occur after transurethral resection (TRUS) for prostate adenoma or radical prostatectomy (RP) for prostate cancer. Internal urethrotomy of these strictures results in a high rate of restricfure due to hypertrophic intraurethral scar tissue. As radiotherapy can prevent hypertrophic processes (e.g. keloids) in other body sites, we examined the effect in prevention of urethral restrictures. Material and methods: Since November 2000, endourethral HDRbrachytherapy(BT) was performed in 5 male patients with recurrent (6-15x) urethral strictures after TRUS (3 pat.) or RP (2 pat.) and in 1 female patient with recurrent strictures of an umbilical stoma after radical cystectomy for bladder cancer. HDR-BT started at the day of the actual urethrotomy and continued the following 3 days. Fractionation was 4x3 Gy up to 12 Gy and, in the last 2 patients, 4x4 Gy up to 16 Gy (192-1r source, 3mm tissue depth, guidant catheter, CT-planning). Follow-up time ranged from 1 to 14 months (median 7,5 months). Results and discussion: 4 of the 6 patients are without recurrence (1-14 months, median 5,5 months). In the patient, who underwent 15 internal urethrotomies, and in the female patient, complete or partial restricture was found 3 months after brachytherapy, and a second brachytherapy with 4x3 Gy was performed. Both patients are now recurrence-free for 3 and 5 months. One of the 6 patients developed an incontinence after the actual urethrotomy. Before radiotherapy, all our 6 patients had to undergo multiple internal urethrotomies and almost monthly interventions (dilatations) associated with recurrent strictures, concomitant infections and the necessity of suprapubic catheterization. In those patients, radiotherapy- induced prevention of rapid restricture meant a dramatic improvement of quality of life.The exact reasons for our two treatment failures remain unclear, nevertheless we adapted our treatment dose to 4x4 Gy on the supposition that this would lead to a better local control. Conclusion: Endourethral HDR-BT is a safe method and can prevent urethral restricture. Further investigations have to evaluate adequate single and total radiation doses and furthermore possible short- and long-term side-effects. 97
poster
Intraluminal high dose rate brachytherapy for ano-rectal cancer - Mount vernon experience S.M. de Canha. P.J. Hoskin, R. Glynne-Jones Mount Vernon, Cancer Centre, Northwood, United Kingdom lntrodu0ti0n: High dose rate intraluminal brachytherapy (ILBT) is used at Mount Vernon Hospital for both palliative and radical treatment of ano-rectal cancer. Materials and methods: From October 1992 to November 2001,49 patients were treated with ILBT using a remote afterloading technique. Thirty-nine patients had rectal cancer, while the remainder had ano-recta[ or anal canal
Posters
tumours. Patients ranged in age from 32 to 97 years (median age 74 years). Two were not evaluable. tLBT was given in the majority of patients with a single line source using a 2cm diameter cylinder. Patients were divided into 2 groups. Group I (34% of patients) received ILBT as consolidation therapy after external beam irradiation. Thirteen patients were treated radically who either had locally advanced, inoperable tumours or were medically unfit for surgery; 3 others treated in this way had liver metastases. Group II (66% of patients) received ILBT as sole local therapy for palliation. The two most commonly used fractionation schedules were a single fraction of 10Gy and 12Gy in 2 fractions, both prescribed at 1cm from the surface of the applicator. Follow-up, in 47 evaluable patients, ranged from 1 week to 6 years and 5 months, with a median of a year after brachytherapy. Results: The median overall survival for the radical group was 2 years and 7 months, with 5 patients living longer than 4 years. In the palliative group, only 4 patients (13%) had no real benefit from the brachytherapy. The rest of this group received good palliation, particularly from rectal bleeding. The majority of patients tolerated the treatment well with only transient, acute reactions. In the radical group, 4 patients (31%) developed late radionecrotic ulcers in the rectum. Conclusion: The Mount Vernon Hospital experience demonstrates that good palliation can be achieved with one or two fractions ILBT and that long term survival can be obtained in patients who receive ILBT as boost therapy after external beam irradiation. 98
poster
Salvage brachytherapy in anal region tumors E. Kavtan 1, I. Aslay 1, I. Ozbay 2, G. Kemikler2, Y. Bozfakioglu 3, E. Darendeliler 1, G. Tore 1 l oncology Institute, Radiation Oncology, Istanbul, Turkey 20ncology Institute, Radiation Physics, Istanbul, Turkey 31stanbul University, Surgery, Istanbul, Turkey Purpose: The aim of this study is to analyze the efficiency of brachytherapy to the anal regions tumors. Materials and method: Between 1993 and 1998; Eight patients with anal canal cancer or rectal adenocarcinoma relapsing at the anal region were treated with bFachytherapy. Brachytherapy was applied together with external radiotherapy in two patients who had no adjuvant therapy after surgery and applied alone for palliative aim in two patients who had anal region relapses. External radiotherapy and brachytherapy was chosen as the primary treatment in three patients who had no surgery. And brachytherapy was also applied in one patient with leiomyosarcoma and one patient with relapsing cervix carcinoma. Results: The patients who were treated for relapse; two had a complete and the other two had a partial response. Of the three patients who had no surgery; two had a complete and one had a partial response. After a complete response; the patient with leiomyosarcoma had a local relapse at the 27th month. Local control had lasted for 10 months for the patient with cervix carcinoma. Conclusion: Beside of saving the sphincter functions, interstitial brachytherapy can be effected as salvage treatment of anal region cancers. And also; it can be combined with external radiotherapy for palliative aim at the local relapses. 99
poster
Brachytherapy in keloids : factors of success and relapse H. Jouhadi. N. Tawfiq, N. Bouih, S. Sahraoui, A. Acharki, A. Benider Ibn Rochd Oncology center, Radiation oncology, Casablanca, Morocco Keloids are frequent in Morocco where black ethnic group is very representative. The medico-surgical treatment is frequently unsuccessful .Therefore the negative psychological impact became considerable. Brachytherapy permits to improve dramatically the results. The goal of this work is to discuss through our experience risk factors for keloids recurrence. The authors reports 63 patient treated by interstitial brachytherapy (iridium 192) after surgical excision. The period of survey extend between January 1990 and January 1999. The mean age was 24 years and the sex-ratio 0, 76. The mean delay to consultation is 4 years. The predominant localization was the ear lobule with 35 cases. The mean size of keloids was of 4.7 cm with a mean weight of 13.5 g (weight of the piece after resection). Forty nine patients were black (77%). The surgical removal was intra-marginal in 37 cases and in healthy skin in
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26 cases. Brachytherapy has always been achieved in intraoperative. Mean delay between surgery and irradiation was 4 hours. The mean delivered dose was 15 grays with extremes of 10 and 18 grays. The mean length of irradiation was 69 hours. After 36 months, 54 patients (86%) didn't relapse. Aesthetic result has been judged satisfactory in 43 cases (79%). No complication has been noticed. Factors of relapse seem to be: a lower do.so(less than 15 grays) and a delay between surgery and irradiation up to 6 hours. Brachytherapy using iridium 192 associated to a surgical excision is a simple treatment, which cost is reasonable and efficiency remarkable in keloids. 100
poster
Endovascular brachytherapy (EVBT) to prevent coronary artery restenosis with gamma and beta irradiation: experience in 54 patients. M.G. Fabrini 1, S. Petronio 2, F. Perrone3 M. Panichi 1, B. Manfredi 1, V. Marchetti 1, A.P. Colantuoni 1, S. Ursino 1, L. Cionini 1 1U.O. Radioterapia, Dpt. Oncologia Universit~ di Pisa, Pisa, Italy 2Emodinamica, Dpt. Cardiotoracico Universitd Pisa, Pisa, Italy 3U.O. Fisica Sanitaria, Az. Ospedaliera Pisana, Pisa, Italy Our experience using EVBT has been started on April 2000. The goal of the study was to evaluate efficacy and safety of EVBT with gamma and beta rays in pts. with restenosis intrastent after PTCA From April 2000 to December 2001 EVBT was performed in 54 pts: 43 M. (79.6%) and 11 F. (20.4%). Their ages ranged from 41-80 yrs (mean 66 yrs). All pts. had an IVUS before EBVT. Nine patients, who had precedent undergone to coronary stenting and more than two times PTCA for subsequent coronary restenosis, were treated with gamma rays (Cordis catheter system with a Ir 192 seeds ribbon); 45 pts. were treated with beta irradiation with a P32 wire source within a centering balloon catheter (Galileo catheter system of Guidant). According to "Granite" protocol a dose of 14 Gy was delivered at a radial depth of 2 mm with the gamma source: the length of stenos is ranged from 6.3 to 39.8 mm, with a mean length of 22.1 mm. The source length used range from 10 to 14 seeds (4mm interaxis): 10 seeds in 3 patients, 14 seeds in 6 pts. The dose of 20 Gy was delivered with the beta source (P32) according the AAPM 60 Task Group recommendation. The length of the stenos is (GTL) ranged from 9 to 58 mm, with a mean length of 19.8 mm, while the source length range from 22 to 72 mm with a median length of 32 mm. To evaluate isodose distribution a three-dimensional physical model had been developed and according to its results maximum and minimum adsorbed doses have been calculated, All the pts. underwent a cardiologic follow up with ECG 12 lead, stress tests at one and six months from the treatment and coronarography at respectively 8 and 18 months. The criteria to evaluate the response were MLD, MLA and % of stenosis of the treated vessel calculated using QCA and IVUS. At the present median follow up is 6,2 months for P32 pts, and at least 15 months for pts. treated with gamma irradiation. Three pts. of the first group presented restenosis, and underwent a new PTCA (30%). One of the pts. treated with P32 with a by pass restenosis needed a new by pass, while 2pts. show actually symptoms of angina but only with ergometric tests and for this not yet evaluated with angiographies. The other pts. don't have any symptoms or instrumental data related with a restenosis. EVBT reduce restenosis % after PTCA, is safety and doesn't show any significant adverse effects. Problems like edge effects, geographical miss, dose prescription need to be resolved and will be objects of future studies 101
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Characterization using the Monte Carlo Code PENELOPE of two sources beta (32P and 90Sr-9OY) for intravascular brachytherapy. A. Sanchez-Reves 1, J. Asenjo 1, A. Rovirosa 1, J~ Fern~ndez-Varea 2 1Hospital Clinic de Barcelona, Servicio de Oncologia Radioterapica, Barcel ona, Spain 2Universidad de Barcelona, Facultad de Fisicas, Barcelona, Spain PvrDose: Dosimetric characterization and dose comparison of 32P and 90Sr-90Y sources for intravascular brachytherapy (IVBT) by means the Monte Carlo (MC) code PENELOPE. Material and Methods: The general-purpose MC PENELOPE has been used to simulate the electron-photon transport of the radiation emitted by 32P (single source of 27 mm long) and 90Sr-90Y ( the train consisted of 12 seeds with a total length of 30 ram) sources. More of 20 million of primary
Posters
ity rate was 22.5%) while 3 died of intercurrent diseases. The 5-year actuarial disease-free survival rate was 56% while the 5-year actuarial overall survival was 70%. Five patients (17%) developed severe wound complications following surgery/brachytherapy and 6 (19%) developed late local tissue toxicity (fibrosis and telangiectasia). Conclusions: Wide local excision followed by interstitial brachytherapy has resulted in an 87% local control rate with a 17% local complication rate. 94
poster
None fracture occurence after surgery, brachytherapy (BCT) and external beam irradiation (EBRT) in soft tissue sarcoma (STS) of the limbs F. Paiar 1, L. Livi 1, G. Piperno 1, S. Scoccianti 1, R. Santoni2, G, Biti 1 1Department of Radiation Oncology, University of Firenze and Roma, 2Tor Vergata, Italy Introduction: in spite of the good results in terms of survival and local control rates after combined treatment (radical surgery followed by irradiation with high doses) of STS the occurrence of severe long term side effects has not yet been fully investigated or reported. In particular the occurrence rate of long bone fractures is not well known, as well as its treatment and outcome. Material and methods: during the period 1990-2000 243 patients affected by STS of the trunk and limbs were referred to the University and Hospital Departments of Orthopaedics and Radiation Therapy of Firenze, Italy. Treatment protocol is based on wide surgical resection of the tumor usually followed by intraoperative implantatioin of catheters for BCT, EBRT is then added to cover a larger volume than that treated with BCT only. BCT is usually delivered a few days after surgery and implantation, in the operative room during resection, of the plastic catheters which will bear the radioactive sources during treatment. Catheters are implanted perpendicular to the surgical wound over its length to cover the tumor bed with a safety margin of 2 - 3 cm. Using 192 Iridium low-dose-rate sources doses ranging between 12 Gy and 60 Gy were delivered to a larger volume then that covered by the BCT treatment. EBRT was usually planned with two opposed fields using high energy photon beams or a direct electron beam field. The total doses delivered to the entire compartment containing the excised tumor ranged between 47 Gy and 95 Gy (median dose 75 Gy). Results: with a median follow-up period of 48 months the 5 year overall survival and relapse free survival were 66% and 69% respectively. Long bone fractures were diagnosed in three patients and all of them required a major surgical treatment (amputation of the leg in one patient). To detect a possible correlation between bone fracture, treatment, patient related factors or tumor related factors these patients were matched towards a group with similar clinical and pathologic features. No differences were found as concerns predictors of increased risk of long bone fracture between the control group and the three reported cases. The authors will describe the features of the entire group of treated patients and the three cases who experienced spontaneous bone fracture during follow-up.
MISCELLANEOUS 95
poster
Geometric analysis of the change of ovoids applicator positions, iCRU-38 rectum and bladder points during multiple HDR brachytherapy fractions F.G. Koseoglu 1, M. Garipagaoglu 1, H. GEflkesen2, N. Tungel 1, A.U. Kizildag 1, M.G. Dalmaz 1, V. Simsir 1, M. Altun 1 1Akdeniz University School of Medicine, Radiation Oncology, Antalya, Turkey 2Akdeniz University School of Medicine, Bioistatistics, Antalya, Turkey Introduction: The reproducibility of intracavitary brachytherapy (IB) applicator positions between fractions is important. Treatment planning and plan optimization for each fraction are recommended by several authors since variation of applicator position, between the fractions. This study investigates the interfractional geometric variation of the High Dose Rate (HDR) IB application using two ovoids for vaginal cuff irradiation, and ICRU-38 rectal reference point (R) and ICRU-38 bladder reference point (BL). Methods: Twenty-four patients with cervical or endometrial carcinoma underwent HDR IB using 2 ovoids were included. Our protocol requires, treatment dose calculation and optimization in each IB fractions using orthogonal radiographs. The point where is located intersection of the line passing over the widest distance of pelvic space in x-axis and the line between middle of lumbar 5 vertebra and middle of upper symphysis pubis
(SP) in y-axis defined as a pelvic centre (PC). On orthogonal radiographs, PC, left pelvic wall (LPW) and right pelvic wall (RPW), upper-middle of the sacral 1 vertebra ($1) and SP were taken as "constant reference points". Top of the right ovoid (RO) and left ovoid (LO), R and BL were defined as "inconstant points". In an effort to obtain the changes of applicator positions, R and BL; 32 different parameters were defined to resemble the distance between constant and inconstant points in x, y and z axis. These 32 parameters were measured, in each HDR IB fraction of 24 patients, with using orthogonal radiographs. To test the significance of change of the parameters within each patient, Friedman test was used. Results: The distance between the ovoids were same in all fractions of each patient. The difference between maximum and minimum of each parameter for each patient was determined. The mean of these differences in x, y and. z axis were: 7.6ram, 13.2mm, 14.2mm for left ovoid, 8.3ram, 13.3mm, 19.5mm for right ovoid, 5.5mm, 19.3mm, 15.4mm for rectum, 13.0 ram, 8.5mm, 10.9mm for bladder respectively. There was no statistically significant change in any measurement for left and right ovoid or R and BL within these subjects. Conclusion: Necessity of treatment planning and optimization in each vaginal cuff HDR IB fractions, with using two ovoids should be analysed by a dosimetric study. 96
poster
Endourethral brachytherapy for prevention of recurrent urethral stricture following internal urethrotomy - First experiences M.-H. S~eoenschmiedt 1, 72 Olschewski 1, D. KrOpfl2 1AIfried Krupp Hospital, Radiooncology, Radiotherapy, Nuclear Medicine, Essen, Germany 2Huyssens-Stiftung, Urology, Essen, Germany Introduction: Urethral strictures often occur after transurethral resection (TRUS) for prostate adenoma or radical prostatectomy (RP) for prostate cancer. Internal urethrotomy of these strictures results in a high rate of restricfure due to hypertrophic intraurethral scar tissue. As radiotherapy can prevent hypertrophic processes (e.g. keloids) in other body sites, we examined the effect in prevention of urethral restrictures. Material and methods: Since November 2000, endourethral HDRbrachytherapy(BT) was performed in 5 male patients with recurrent (6-15x) urethral strictures after TRUS (3 pat.) or RP (2 pat.) and in 1 female patient with recurrent strictures of an umbilical stoma after radical cystectomy for bladder cancer. HDR-BT started at the day of the actual urethrotomy and continued the following 3 days. Fractionation was 4x3 Gy up to 12 Gy and, in the last 2 patients, 4x4 Gy up to 16 Gy (192-1r source, 3mm tissue depth, guidant catheter, CT-planning). Follow-up time ranged from 1 to 14 months (median 7,5 months). Results and discussion: 4 of the 6 patients are without recurrence (1-14 months, median 5,5 months). In the patient, who underwent 15 internal urethrotomies, and in the female patient, complete or partial restricture was found 3 months after brachytherapy, and a second brachytherapy with 4x3 Gy was performed. Both patients are now recurrence-free for 3 and 5 months. One of the 6 patients developed an incontinence after the actual urethrotomy. Before radiotherapy, all our 6 patients had to undergo multiple internal urethrotomies and almost monthly interventions (dilatations) associated with recurrent strictures, concomitant infections and the necessity of suprapubic catheterization. In those patients, radiotherapy- induced prevention of rapid restricture meant a dramatic improvement of quality of life.The exact reasons for our two treatment failures remain unclear, nevertheless we adapted our treatment dose to 4x4 Gy on the supposition that this would lead to a better local control. Conclusion: Endourethral HDR-BT is a safe method and can prevent urethral restricture. Further investigations have to evaluate adequate single and total radiation doses and furthermore possible short- and long-term side-effects. 97
poster
Intraluminal high dose rate brachytherapy for ano-rectal cancer - Mount vernon experience S.M. de Canha. P.J. Hoskin, R. Glynne-Jones Mount Vernon, Cancer Centre, Northwood, United Kingdom lntrodu0ti0n: High dose rate intraluminal brachytherapy (ILBT) is used at Mount Vernon Hospital for both palliative and radical treatment of ano-rectal cancer. Materials and methods: From October 1992 to November 2001,49 patients were treated with ILBT using a remote afterloading technique. Thirty-nine patients had rectal cancer, while the remainder had ano-recta[ or anal canal
Posters
tumours. Patients ranged in age from 32 to 97 years (median age 74 years). Two were not evaluable. tLBT was given in the majority of patients with a single line source using a 2cm diameter cylinder. Patients were divided into 2 groups. Group I (34% of patients) received ILBT as consolidation therapy after external beam irradiation. Thirteen patients were treated radically who either had locally advanced, inoperable tumours or were medically unfit for surgery; 3 others treated in this way had liver metastases. Group II (66% of patients) received ILBT as sole local therapy for palliation. The two most commonly used fractionation schedules were a single fraction of 10Gy and 12Gy in 2 fractions, both prescribed at 1cm from the surface of the applicator. Follow-up, in 47 evaluable patients, ranged from 1 week to 6 years and 5 months, with a median of a year after brachytherapy. Results: The median overall survival for the radical group was 2 years and 7 months, with 5 patients living longer than 4 years. In the palliative group, only 4 patients (13%) had no real benefit from the brachytherapy. The rest of this group received good palliation, particularly from rectal bleeding. The majority of patients tolerated the treatment well with only transient, acute reactions. In the radical group, 4 patients (31%) developed late radionecrotic ulcers in the rectum. Conclusion: The Mount Vernon Hospital experience demonstrates that good palliation can be achieved with one or two fractions ILBT and that long term survival can be obtained in patients who receive ILBT as boost therapy after external beam irradiation. 98
poster
Salvage brachytherapy in anal region tumors E. Kavtan 1, I. Aslay 1, I. Ozbay 2, G. Kemikler2, Y. Bozfakioglu 3, E. Darendeliler 1, G. Tore 1 l oncology Institute, Radiation Oncology, Istanbul, Turkey 20ncology Institute, Radiation Physics, Istanbul, Turkey 31stanbul University, Surgery, Istanbul, Turkey Purpose: The aim of this study is to analyze the efficiency of brachytherapy to the anal regions tumors. Materials and method: Between 1993 and 1998; Eight patients with anal canal cancer or rectal adenocarcinoma relapsing at the anal region were treated with bFachytherapy. Brachytherapy was applied together with external radiotherapy in two patients who had no adjuvant therapy after surgery and applied alone for palliative aim in two patients who had anal region relapses. External radiotherapy and brachytherapy was chosen as the primary treatment in three patients who had no surgery. And brachytherapy was also applied in one patient with leiomyosarcoma and one patient with relapsing cervix carcinoma. Results: The patients who were treated for relapse; two had a complete and the other two had a partial response. Of the three patients who had no surgery; two had a complete and one had a partial response. After a complete response; the patient with leiomyosarcoma had a local relapse at the 27th month. Local control had lasted for 10 months for the patient with cervix carcinoma. Conclusion: Beside of saving the sphincter functions, interstitial brachytherapy can be effected as salvage treatment of anal region cancers. And also; it can be combined with external radiotherapy for palliative aim at the local relapses. 99
poster
Brachytherapy in keloids : factors of success and relapse H. Jouhadi. N. Tawfiq, N. Bouih, S. Sahraoui, A. Acharki, A. Benider Ibn Rochd Oncology center, Radiation oncology, Casablanca, Morocco Keloids are frequent in Morocco where black ethnic group is very representative. The medico-surgical treatment is frequently unsuccessful .Therefore the negative psychological impact became considerable. Brachytherapy permits to improve dramatically the results. The goal of this work is to discuss through our experience risk factors for keloids recurrence. The authors reports 63 patient treated by interstitial brachytherapy (iridium 192) after surgical excision. The period of survey extend between January 1990 and January 1999. The mean age was 24 years and the sex-ratio 0, 76. The mean delay to consultation is 4 years. The predominant localization was the ear lobule with 35 cases. The mean size of keloids was of 4.7 cm with a mean weight of 13.5 g (weight of the piece after resection). Forty nine patients were black (77%). The surgical removal was intra-marginal in 37 cases and in healthy skin in
$29
26 cases. Brachytherapy has always been achieved in intraoperative. Mean delay between surgery and irradiation was 4 hours. The mean delivered dose was 15 grays with extremes of 10 and 18 grays. The mean length of irradiation was 69 hours. After 36 months, 54 patients (86%) didn't relapse. Aesthetic result has been judged satisfactory in 43 cases (79%). No complication has been noticed. Factors of relapse seem to be: a lower do.so(less than 15 grays) and a delay between surgery and irradiation up to 6 hours. Brachytherapy using iridium 192 associated to a surgical excision is a simple treatment, which cost is reasonable and efficiency remarkable in keloids. 100
poster
Endovascular brachytherapy (EVBT) to prevent coronary artery restenosis with gamma and beta irradiation: experience in 54 patients. M.G. Fabrini 1, S. Petronio 2, F. Perrone3 M. Panichi 1, B. Manfredi 1, V. Marchetti 1, A.P. Colantuoni 1, S. Ursino 1, L. Cionini 1 1U.O. Radioterapia, Dpt. Oncologia Universit~ di Pisa, Pisa, Italy 2Emodinamica, Dpt. Cardiotoracico Universitd Pisa, Pisa, Italy 3U.O. Fisica Sanitaria, Az. Ospedaliera Pisana, Pisa, Italy Our experience using EVBT has been started on April 2000. The goal of the study was to evaluate efficacy and safety of EVBT with gamma and beta rays in pts. with restenosis intrastent after PTCA From April 2000 to December 2001 EVBT was performed in 54 pts: 43 M. (79.6%) and 11 F. (20.4%). Their ages ranged from 41-80 yrs (mean 66 yrs). All pts. had an IVUS before EBVT. Nine patients, who had precedent undergone to coronary stenting and more than two times PTCA for subsequent coronary restenosis, were treated with gamma rays (Cordis catheter system with a Ir 192 seeds ribbon); 45 pts. were treated with beta irradiation with a P32 wire source within a centering balloon catheter (Galileo catheter system of Guidant). According to "Granite" protocol a dose of 14 Gy was delivered at a radial depth of 2 mm with the gamma source: the length of stenos is ranged from 6.3 to 39.8 mm, with a mean length of 22.1 mm. The source length used range from 10 to 14 seeds (4mm interaxis): 10 seeds in 3 patients, 14 seeds in 6 pts. The dose of 20 Gy was delivered with the beta source (P32) according the AAPM 60 Task Group recommendation. The length of the stenos is (GTL) ranged from 9 to 58 mm, with a mean length of 19.8 mm, while the source length range from 22 to 72 mm with a median length of 32 mm. To evaluate isodose distribution a three-dimensional physical model had been developed and according to its results maximum and minimum adsorbed doses have been calculated, All the pts. underwent a cardiologic follow up with ECG 12 lead, stress tests at one and six months from the treatment and coronarography at respectively 8 and 18 months. The criteria to evaluate the response were MLD, MLA and % of stenosis of the treated vessel calculated using QCA and IVUS. At the present median follow up is 6,2 months for P32 pts, and at least 15 months for pts. treated with gamma irradiation. Three pts. of the first group presented restenosis, and underwent a new PTCA (30%). One of the pts. treated with P32 with a by pass restenosis needed a new by pass, while 2pts. show actually symptoms of angina but only with ergometric tests and for this not yet evaluated with angiographies. The other pts. don't have any symptoms or instrumental data related with a restenosis. EVBT reduce restenosis % after PTCA, is safety and doesn't show any significant adverse effects. Problems like edge effects, geographical miss, dose prescription need to be resolved and will be objects of future studies 101
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Characterization using the Monte Carlo Code PENELOPE of two sources beta (32P and 90Sr-9OY) for intravascular brachytherapy. A. Sanchez-Reves 1, J. Asenjo 1, A. Rovirosa 1, J~ Fern~ndez-Varea 2 1Hospital Clinic de Barcelona, Servicio de Oncologia Radioterapica, Barcel ona, Spain 2Universidad de Barcelona, Facultad de Fisicas, Barcelona, Spain PvrDose: Dosimetric characterization and dose comparison of 32P and 90Sr-90Y sources for intravascular brachytherapy (IVBT) by means the Monte Carlo (MC) code PENELOPE. Material and Methods: The general-purpose MC PENELOPE has been used to simulate the electron-photon transport of the radiation emitted by 32P (single source of 27 mm long) and 90Sr-90Y ( the train consisted of 12 seeds with a total length of 30 ram) sources. More of 20 million of primary